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Tengman, Eva
Publications (10 of 28) Show all publications
Grip, H., Tengman, E., Liebermann, D. G. & Häger, C. (2019). Kinematic analyses including finite helical axes of drop jump landings demonstrate decreased knee control long after anterior cruciate ligament injury. PLoS ONE, 14(10), Article ID e0224261.
Open this publication in new window or tab >>Kinematic analyses including finite helical axes of drop jump landings demonstrate decreased knee control long after anterior cruciate ligament injury
2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 10, article id e0224261Article in journal (Refereed) Published
Abstract [en]

The purpose was to evaluate the dynamic knee control during a drop jump test following injury of the anterior cruciate ligament injury (ACL) using finite helical axes. Persons injured 17-28 years ago, treated with either physiotherapy (ACLPT, n = 23) or reconstruction and physiotherapy (ACLR, n = 28) and asymptomatic controls (CTRL, n = 22) performed a drop jump test, while kinematics were registered by motion capture. We analysed the Preparation phase (from maximal knee extension during flight until 50 ms post-touchdown) followed by an Action phase (until maximal knee flexion post-touchdown). Range of knee motion (RoM), and the length of each phase (Duration) were computed. The finite knee helical axis was analysed for momentary intervals of ~15° of knee motion by its intersection (ΔAP position) and inclination (ΔAP Inclination) with the knee's Anterior-Posterior (AP) axis. Static knee laxity (KT100) and self-reported knee function (Lysholm score) were also assessed. The results showed that both phases were shorter for the ACL groups compared to controls (CTRL-ACLR: Duration 35±8 ms, p = 0.000, CTRL-ACLPT: 33±9 ms, p = 0.000) and involved less knee flexion (CTRL-ACLR: RoM 6.6±1.9°, p = 0.002, CTRL-ACLR: 7.5 ±2.0°, p = 0.001). Low RoM and Duration correlated significantly with worse knee function according to Lysholm and higher knee laxity according to KT-1000. Three finite helical axes were analysed. The ΔAP position for the first axis was most anterior in ACLPT compared to ACLR (ΔAP position -1, ACLPT-ACLR: 13±3 mm, p = 0.004), with correlations to KT-1000 (rho 0.316, p = 0.008), while the ΔAP inclination for the third axis was smaller in the ACLPT group compared to controls (ΔAP inclination -3 ACLPT-CTRL: -13±5°, p = 0.004) and showed a significant side difference in ACL injured groups during Action (Injured-Non-injured: 8±2.7°, p = 0.006). Small ΔAP inclination -3 correlated with low Lysholm (rho 0.391, p = 0.002) and high KT-1000 (rho -0.450, p = 0.001). Conclusions Compensatory movement strategies seem to be used to protect the injured knee during landing. A decreased ΔAP inclination in injured knees during Action suggests that the dynamic knee control may remain compromised even long after injury.

National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-165229 (URN)10.1371/journal.pone.0224261 (DOI)31671111 (PubMedID)
Available from: 2019-11-15 Created: 2019-11-15 Last updated: 2019-11-18Bibliographically approved
Strong, A., Tengman, E., Srinivasan, D. & Häger, C. K. (2019). One-leg rise performance and associated knee kinematics in ACL-deficient and ACL-reconstructed persons 23 years post-injury. BMC Musculoskeletal Disorders, 20(1), Article ID 476.
Open this publication in new window or tab >>One-leg rise performance and associated knee kinematics in ACL-deficient and ACL-reconstructed persons 23 years post-injury
2019 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 20, no 1, article id 476Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Research indicates reduced knee function and stability decades after anterior cruciate ligament (ACL) injury. Assessment requires reliable functional tests that discriminate such outcomes from asymptomatic knees, while providing suitable loading for different populations. The One-leg rise (OLR) test is common in clinics and research but lacks scientific evidence for its implementation. Our cross-sectional study compared performance including knee kinematics of the OLR between ACL-injured persons in the very long term to controls and between legs within these groups, and assessed the within-session reliability of the kinematics.

METHODS: Seventy ACL-injured individuals (mean age 46.9 ± 5.4 years) treated with either reconstructive surgery and physiotherapy (ACLR; n = 33) or physiotherapy alone (ACLPT; n = 37), on average 23 years post-injury, and 33 age- and sex-matched controls (CTRL) attempted the OLR. Participants completed as many repetitions as possible to a maximum of 50 while recorded by motion capture. We compared between all groups and between legs within groups for total repetitions and decomposed the OLR into movement phases to compare phase completion times, maximum and range of knee abduction and adduction angles, and mediolateral knee control in up to 10 repetitions per participant.

RESULTS: ACLPT performed significantly fewer OLR repetitions with their injured leg compared to the CTRL non-dominant leg (medians 15 and 32, respectively) and showed significantly greater knee abduction than ACLR and CTRL (average 2.56°-3.69° depending on phase and leg). Distribution of repetitions differed between groups, revealing 59% of ACLPT unable to complete more than 20 repetitions on their injured leg compared to 33% ACLR and 36% CTRL for their injured and non-dominant leg, respectively. Within-session reliability of all kinematic variables for all groups and legs was high (ICC 3,10 0.97-1.00, 95% CI 0.95-1.00, SEM 0.93-1.95°).

CONCLUSIONS: Negative outcomes of OLR performance, particularly among ACLPT, confirm the need to address aberrant knee function and stability even decades post-ACL injury. Knee kinematics derived from the OLR were reliable for asymptomatic and ACL-injured knees. Development of the OLR protocol and analysis methods may improve its discriminative ability in identifying reduced knee function and stability among a range of clinical populations.

Keywords
Biomechanics, Clinical assessment, Knee control, Knee function, Knee injury, Lower limb, Motion analysis, Osteoarthritis
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-165230 (URN)10.1186/s12891-019-2887-3 (DOI)000492891600003 ()31653212 (PubMedID)
Available from: 2019-11-15 Created: 2019-11-15 Last updated: 2019-11-28Bibliographically approved
Arumugam, A., Strong, A., Tengman, E., Röijezon, U. & Häger, C. (2019). Psychometric properties of knee proprioception tests targeting healthy individuals and those with anterior cruciate ligament injury managed with or without reconstruction: a systematic review protocol. BMJ Open, 9(4), Article ID e027241.
Open this publication in new window or tab >>Psychometric properties of knee proprioception tests targeting healthy individuals and those with anterior cruciate ligament injury managed with or without reconstruction: a systematic review protocol
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 4, article id e027241Article, review/survey (Refereed) Published
Abstract [en]

Introduction: An anterior cruciate ligament (ACL) injury affects knee proprioception and sensorimotor control and might contribute to an increased risk of a second ACL injury and secondary knee osteoarthritis. Therefore, there is a growing need for valid, reliable and responsive knee proprioception tests. No previous study has comprehensively reviewed all the relevant psychometric properties (PMPs) of these tests together. The aim of this review protocol is to narrate the steps involved in synthesising the evidence for the PMPs of specific knee proprioception tests among individuals with an ACL injury and knee-healthy controls.

Methods and analysis: The Preferred Reporting Items for Systematic reviews and Meta-Analyses will be followed to report the review. A combination of four conceptual groups of terms-(1) construct (knee proprioception), (2) target population (healthy individuals and those with an ACL injury managed conservatively or with a surgical reconstruction), (3) measurement instrument (specific knee proprioception tests) and (4) PMPs (reliability, validity and responsiveness)-will be used for electronic databases search. PubMed, AMED, CINAHL, SPORTDiscus, Web of Science, Scopus, the Cochrane Central Register of Controlled Trials and ProQuest will be searched from their inception to November 2018. Two reviewers will independently screen titles, abstracts and full text articles, extract data and perform risk of bias assessment using the updated COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist for the eligible studies. A narrative synthesis of the findings and a meta-analysis will be attempted as appropriate. Each PMP of knee proprioception tests will be classified as 'sufficient', 'indeterminate' or 'insufficient'. The overall level of evidence will be ascertained using an established set of criteria.

Ethics and dissemination: Ethical approval or patient consent is not required for a systematic review. The review findings will be submitted as a series of manuscripts for peer-review and publication in scientific journals.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-161462 (URN)10.1136/bmjopen-2018-027241 (DOI)000471157200233 ()30948613 (PubMedID)
Funder
Swedish Research Council, K2014-99X-21876-04-4Västerbotten County Council, VLL548501
Available from: 2019-07-09 Created: 2019-07-09 Last updated: 2019-07-09Bibliographically approved
Markström, J. L., Tengman, E. & Häger, C. (2018). ACL-reconstructed and ACL-deficient individuals show differentiated trunk, hip, and knee kinematics during vertical hops more than 20 years post-injury. Knee Surgery, Sports Traumatology, Arthroscopy, 26(2), 358-367
Open this publication in new window or tab >>ACL-reconstructed and ACL-deficient individuals show differentiated trunk, hip, and knee kinematics during vertical hops more than 20 years post-injury
2018 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 26, no 2, p. 358-367Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Little is known regarding movement strategies in the long term following injury of the anterior cruciate ligament (ACL), and even less about comparisons of reconstructed and deficient knees in relation to healthy controls. The present purpose was to compare trunk, hip, and knee kinematics during a one-leg vertical hop (VH) ~20 years post-ACL injury between persons treated with surgery and physiotherapy (ACLR), solely physiotherapy (ACLPT), and controls (CTRL). Between-leg kinematic differences within groups were also investigated.

METHODS: Sixty-six persons who suffered unilateral ACL injury on average 23 ± 2 years ago (32 ACLR, 34 ACLPT) and 33 controls performed the VH. Peak trunk, hip, and knee angles during Take-off and Landing phases recorded with a 3D motion capture system were analysed with multivariate statistics.

RESULTS: Significant group effects during both Take-off and Landing were found, with ACLPT differing from CTRL in Take-off with a combination of less knee flexion and knee internal rotation, and from both ACLR and CTRL in Landing with less hip and knee flexion, knee internal rotation, and greater hip adduction. ACLR also presented different kinematics to ACLPT and CTRL in Take-off with a combination of greater trunk flexion, hip flexion, hip internal rotation, and less knee abduction, and in Landing with greater trunk flexion and hip internal rotation. Further, different kinematics and hop height were found between legs within groups in both Take-off and Landing for both ACL groups, but not for CTRL.

CONCLUSION: Different kinematics for the injured leg for both ACL groups compared to CTRL and between treatment groups, as well as between legs within treatment groups, indicate long-term consequences of injury. Compensatory mechanisms for knee protection seem to prevail over time irrespective of initial treatment, possibly increasing the risk of re-injury and triggering the development of osteoarthritis. Detailed investigation of movement strategies during the VH provides important information and a more comprehensive evaluation of knee function than merely hop height. More attention should also be given to the trunk and hip in clinics when evaluating movement strategies after ACL injury.

LEVEL OF EVIDENCE: Prospective cohort study, Level II.

Keywords
Anterior cruciate ligament, Long-term, Movement strategy, One-leg vertical hop, Treatment
National Category
Physiotherapy
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-144713 (URN)10.1007/s00167-017-4528-4 (DOI)000424056400002 ()28337590 (PubMedID)
Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2019-05-20Bibliographically approved
Hébert-Losier, K., Schelin, L., Tengman, E., Strong, A. & Häger, C. (2018). Curve analyses reveal altered knee, hip, and trunk kinematics during drop-jumps long after anterior cruciate ligament rupture. Knee (Oxford), 25(2), 226-239
Open this publication in new window or tab >>Curve analyses reveal altered knee, hip, and trunk kinematics during drop-jumps long after anterior cruciate ligament rupture
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2018 (English)In: Knee (Oxford), ISSN 0968-0160, E-ISSN 1873-5800, Vol. 25, no 2, p. 226-239Article in journal (Refereed) Published
Abstract [en]

Background: Anterior cruciate ligament (ACL) ruptures may lead to knee dysfunctions later in life. Single-leg tasks are often evaluated, but bilateral movements may also be compromised. Our aim was to use curve analyses to examine double-leg drop–jump kinematics in ACL-reconstructed, ACL-deficient, and healthy-knee cohorts.

Methods: Subjects with unilateral ACL ruptures treated more than two decades ago (17–28 years) conservatively with physiotherapy (ACLPT, n = 26) or in combination with reconstructive surgery (ACLR, n = 28) and healthy-knee controls (n = 25) performed 40-cm drop–jumps. Three-dimensional knee, hip, and trunk kinematics were analyzed during Rebound, Flight, and Landing phases. Curves were time-normalized and compared between groups (injured and non-injured legs of ACLPT and ACLR vs. non-dominant and dominant legs of controls) and within groups (between legs) using functional analysis of variance methods.

Results: Compared to controls, ACL groups exhibited less knee and hip flexion on both legs during Rebound and greater knee external rotation on their injured leg at the start of Rebound and Landing. ACLR also showed less trunk flexion during Rebound. Between-leg differences were observed in ACLR only, with the injured leg more internally rotated at the hip. Overall, kinematic curves were similar between ACLR and ACLPT. However, compared to controls, deviations spanned a greater proportion of the drop–jump movement at the hip in ACLR and at the knee in ACLPT.

Conclusions: Trunk and bilateral leg kinematics during double-leg drop–jumps are still compromised long after ACL-rupture care, independent of treatment. Curve analyses indicate the presence of distinct compensatory mechanisms in ACLPT and ACLR compared to controls.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
ACL, Biomechanics, Functional data analysis, Interval testing procedure, Lower extremity, Rehabilitation
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-145719 (URN)10.1016/j.knee.2017.12.005 (DOI)000430519800004 ()29525548 (PubMedID)2-s2.0-85042919592 (Scopus ID)
Available from: 2018-03-15 Created: 2018-03-15 Last updated: 2018-09-19Bibliographically approved
Markström, J., Tengman, E. & Häger, C. (2018). Different dynamic knee stability and frontal plane kinematics and kinetics between landings in common one-leg hops for ACL-reconstructed women and knee-healthy controls. In: 8th World Congress of Biomechanics, Dublin, July 8-12, 2018: . Paper presented at 8th World Congress of Biomechanics, Dublin, July 8-12, 2018.
Open this publication in new window or tab >>Different dynamic knee stability and frontal plane kinematics and kinetics between landings in common one-leg hops for ACL-reconstructed women and knee-healthy controls
2018 (English)In: 8th World Congress of Biomechanics, Dublin, July 8-12, 2018, 2018Conference paper, Poster (with or without abstract) (Refereed)
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-150559 (URN)
Conference
8th World Congress of Biomechanics, Dublin, July 8-12, 2018
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-08-21
Srinivasan, D., Tengman, E. & Häger, C. K. (2018). Increased movement variability in one-leg hops about 20 years after treatment of anterior cruciate ligament injury. Clinical Biomechanics, 53, 37-45
Open this publication in new window or tab >>Increased movement variability in one-leg hops about 20 years after treatment of anterior cruciate ligament injury
2018 (English)In: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 53, p. 37-45Article in journal (Refereed) Published
Abstract [en]

Background: Recent studies highlight the need for understanding movement control of adjacent joints when evaluating knee function following anterior cruciate ligament (ACL) injury. However, while short-term adaptations to lower-extremity joint coupling have been studied, little is known about any potential long-term adaptations in neuromuscular control displayed by ACL-injured individuals. The aim of our study was to determine whether coordination variability of the hip-knee joint couplings during the one-leg hop is altered about 20 years after injury in two ACL-injured groups compared to healthy knee controls.

Methods: Seventy persons performed one leg hops ~23 years after ACL injury and following different treatments: 33 participants treated with physiotherapy in combination with ACL-reconstruction (ACLR); 37 participants with physiotherapy alone (ACLPT). They were compared to 33 matched controls. A vector coding procedure was used to create joint couplings for knee and hip angles on all the cardinal planes for the Take-off and Landing phases. The standard deviation of each coupling was computed as a measure of coordination variability.

Findings: Both the ACL groups differed significantly from controls on their injured side with ~50% higher knee abduction-adduction/hip internal-external rotation variability during the Take-off phase; ~33% higher knee abduction-adduction/knee flexion-extension variability and greater knee abduction-adduction/hip flexion-extension variability (ACLR 50%; ACLPT 80%) during the Landing phase. There were no major differences between injured and non-injured sides in any group.

Interpretation: Increased variability in lower-extremity joint couplings has emerged as a conspicuous feature of ACL injured persons in the very long term compared to non-injured controls, independent of treatment. Further research of the processes leading to alterations in movement variability using longitudinal studies would facilitate better understanding of the functional adaptations leading to knee dysfunction in the short- and long-term after ACL injury.

Keywords
vector coding, movement variability, kinematics, ACL reconstruction, physiotherapy
National Category
Physiotherapy
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-144718 (URN)10.1016/j.clinbiomech.2018.02.003 (DOI)29433043 (PubMedID)
Available from: 2018-02-12 Created: 2018-02-12 Last updated: 2018-06-09Bibliographically approved
Schelin, L., Tengman, E., Ryden, P. & Häger, C. (2017). A statistically compiled test battery for feasible evaluation of knee function after rupture of the Anterior Cruciate Ligament - derived from long-term follow-up data.. PLoS ONE, 12(5), Article ID e0176247.
Open this publication in new window or tab >>A statistically compiled test battery for feasible evaluation of knee function after rupture of the Anterior Cruciate Ligament - derived from long-term follow-up data.
2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 5, article id e0176247Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Clinical test batteries for evaluation of knee function after injury to the Anterior Cruciate Ligament (ACL) should be valid and feasible, while reliably capturing the outcome of rehabilitation. There is currently a lack of consensus as to which of the many available assessment tools for knee function that should be included. The present aim was to use a statistical approach to investigate the contribution of frequently used tests to avoid redundancy, and filter them down to a proposed comprehensive and yet feasible test battery for long-term evaluation after ACL injury.

METHODS: In total 48 outcome variables related to knee function, all potentially relevant for a long-term follow-up, were included from a cross-sectional study where 70 ACL-injured (17-28 years post injury) individuals were compared to 33 controls. Cluster analysis and logistic regression were used to group variables and identify an optimal test battery, from which a summarized estimator of knee function representing various functional aspects was derived.

RESULTS: As expected, several variables were strongly correlated, and the variables also fell into logical clusters with higher within-correlation (max ρ = 0.61) than between clusters (max ρ = 0.19). An extracted test battery with just four variables assessing one-leg balance, isokinetic knee extension strength and hop performance (one-leg hop, side hop) were mathematically combined to an estimator of knee function, which acceptably classified ACL-injured individuals and controls. This estimator, derived from objective measures, correlated significantly with self-reported function, e.g. Lysholm score (ρ = 0.66; p<0.001).

CONCLUSIONS: The proposed test battery, based on a solid statistical approach, includes assessments which are all clinically feasible, while also covering complementary aspects of knee function. Similar test batteries could be determined for earlier phases of ACL rehabilitation or to enable longitudinal monitoring. Such developments, established on a well-grounded consensus of measurements, would facilitate comparisons of studies and enable evidence-based rehabilitation.

National Category
Physiotherapy Probability Theory and Statistics
Identifiers
urn:nbn:se:umu:diva-135155 (URN)10.1371/journal.pone.0176247 (DOI)000400645000024 ()28459885 (PubMedID)
Available from: 2017-05-19 Created: 2017-05-19 Last updated: 2018-06-09Bibliographically approved
Sole, G., Pataky, T., Tengman, E. & Häger, C. (2017). Analysis of three-dimensional knee kinematics during stair descent two decades post-ACL rupture: Data revisited using statistical parametric mapping. Journal of Electromyography & Kinesiology, 32, 44-50
Open this publication in new window or tab >>Analysis of three-dimensional knee kinematics during stair descent two decades post-ACL rupture: Data revisited using statistical parametric mapping
2017 (English)In: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 32, p. 44-50Article in journal (Refereed) Published
Abstract [en]

Changes in movement patterns following knee injuries have generally used analyses of pre-defined discrete event-related variables, whereas Statistical Parametric Mapping (SPM) assesses continuous data over time. We applied SPM to test differences for knee trajectories during stair descent between participants with past anterior cruciate ligament (ACL) rupture who underwent reconstruction or only physical therapy compared to healthy controls. Three-dimensional knee joint kinematics during stair descent were registered for 31 subjects with ACL reconstruction (ACLR), 36 subjects with ACL rupture managed with physical therapy only (ACLPT) (∼23years post-injury), and 32 uninjured controls. SPM was used to assess differences between groups for the entire three-component knee trajectory. A significant difference between the three groups was found for the first ∼10% of stance phase. Post-hoc analyses showed between-group differences when comparing the ACLPT to the control groups. Analyses of ACLPT versus control groups for individual vector components suggested a combination of less flexion at initial foot contact, and less adduction during weight acceptance (∼40% of stance). Altered knee kinematics were confirmed during weight acceptance of stair descent for the ACLPT group compared to controls, but not for ACLR group. Further exploration of the use of SPM and agreement with clinical gait assessment is warranted.

Keywords
Stair ambulation, Anterior cruciate ligament rupture, Kinematics, Statistical parametric mapping
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-130669 (URN)10.1016/j.jelekin.2016.12.005 (DOI)000396887300008 ()28039768 (PubMedID)
Available from: 2017-01-27 Created: 2017-01-27 Last updated: 2019-05-10Bibliographically approved
Markström, J. L., Tengman, E., Grip, H., Schelin, L. & Häger, C. K. (2016). A comparison of knee joint kinematics and kinetics during landings in three one-leg hop tests (hop for distance, vertical hop and side hop) performed by female elite floorball athletes. In: XXI ISEK Congress: Bridges to Innovation. Paper presented at 21st International Society of Electrophysiology and Kinesiology, Chicago, July 5-8, 2016.
Open this publication in new window or tab >>A comparison of knee joint kinematics and kinetics during landings in three one-leg hop tests (hop for distance, vertical hop and side hop) performed by female elite floorball athletes
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2016 (English)In: XXI ISEK Congress: Bridges to Innovation, 2016Conference paper, Poster (with or without abstract) (Refereed)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-144890 (URN)
Conference
21st International Society of Electrophysiology and Kinesiology, Chicago, July 5-8, 2016
Available from: 2018-02-15 Created: 2018-02-15 Last updated: 2018-06-09Bibliographically approved
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